1. SAG-USG Joint 5-Year Partnership Framework (PF) and Partnership Framework Implementation Plan (PFIP) 2012/13 – 2016/17 KwaZulu Natal SAG PEPFAR All Partners’ Meeting 28 November 2011

2. Key Questions for PEPFAR Where were we? Where are we? What has changed? Where are we going?

3. Where were we? South Africa Scale of SA HIV epidemic huge Consequences of SA HIV epidemic staggering (morbidity, mortality, orphans, stigma) AIDS Denialism slowed effective response Tools to respond limited: ART, palliative care, VCT, AB(C)

4. PEPFAR PEPFAR started as an Emergency Plan Put as many people on ART as quickly as possible Rapidly scale-up of programs Rapid and substantial increase in funding 2004 – 08

5. Principles of the South Africa PEPFAR Program Core Principle Interagency Cooperation in a single program 1.Partner with South African Government 2.Support the South African National Strategic Plan 3.Fewer partners, but work with more indigenous organizations 4.Build on demonstrated success 5.Develop local capacity 6.Plan for sustainability

6. South African Government Partnerships Supporting the South African Government is a Core Principle of PEPFAR in South Africa –Department of Health –Department of Correctional Services –South African National Defence Force (including Military Health Services) –Department of Social Development –Department of Education –Provincial Departments of Health

7. PEPFAR Operations in SA U.S. President's Emergency Plan for AIDS Relief: Office of International Health, PEPFAR Secretariat, South Africa Office of the Global AIDS Coordinator (OGAC), Washington DC U.S. Agency for International Development (USAID) Ambassador’s Community Grants Program U.S. Department of Defense Centers for Disease Control and Prevention (CDC) Coordination, Collaboration, Support of PEPFAR Implementing Agencies Peace Corps

8. South Africa PEPFAR Funding

9. 148 prime implementing partners (contractors and grantees) and more than 650 sub-partners working throughout the nine provinces USAID and CDC PEPFAR PROGRAM

10. Unintended Consequences Weak coordination of scale-up Duplication and gaps in coverage Duplication/innovation – HMIS systems, training curricula, training, … Systems Parallel to SAG response created SAG Ownership of PEPFAR not enough, although aligned Decision-making processes not shared

11. What has Changed? Huge achievements in South Africa Political mandate to strengthen the National HIV Response Vibrant visionary leadership in health Roll out of new strategies to increase access and control HIV Expanding portfolio of prevention interventions

13. Achievements About 1.7 million South African on ART Mother-to-Child- Transmission decreased to 3.5% HIV Incidence decreased 25% between 2001 and 2009

14. PEPFAR Reauthorization Moving from Emergency to Sustainability o Strengthen SA leadership in PEPFAR SA program activities o Transition progressively PEPFAR operations from direct service delivery to technical assistance and capacity building o Expand prevention Partnership Framework (PF) and PFIP o Sets new course for change o Change in doing business

15. What is the PF? The PF is a 5-year joint strategic framework for cooperation between the US and SA governments, and other partners to combat HIV/AIDS and TB in South Africa. Key themes in the PF? Efficiency Sustainability

16. Stage 1: Partnership Framework (PF) 1.Establish collaborative relationship 2.Negotiate overarching 5-year goals of PF and commitments of each party 3.Synthesize agreements into a concise signed document PF signed December 14, 2010 Stage 2: Partnership Framework Implementation Plan (PFIP) Develop an Implementation Plan that Includes specific strategies to achieve 5 year Goals and Objectives in the PF Framework Stages

17. Focus of the PF Purpose To improve the effectiveness, efficiency and sustainability of the South African national HIV and TB response. Guiding Principles o South African Leadership o Alignment o Sustainability o Innovation & Responsiveness o Mutual Accountability o Multi-Sectoral Engagement & Participation o Gender Sensitivity o Financial Commitments & Transparency

18. PF Goals o Prevent new HIV & TB infections o Increase life expectancy and improve the quality of life for people living with and affected by HIV & TB o Strengthen the effectiveness of the HIV & TB response The goals of the PF are based on SA priorities:

19. Goal 1 Objectives o Expand biomedical and behavioral prevention interventions that address the various drivers of the epidemics o Reduce vulnerability to HIV & TB infection, especially focusing on the needs of infants, girls and women o Increase the number of persons who know their HIV & TB status and link them to appropriate services Prevent new HIV & TB infections

20. Goal 2 Objectives Increase life expectancy and improve the quality of life for people living with and affected by HIV & TB o Expand integrated treatment, care, and support services o Decrease infant, child, and maternal mortality due to HIV&AIDS and TB o Mitigate the impact of HIV & AIDS and TB on individuals, families and communities, especially OVC

21. Goal 3 Objectives Strengthen the effectiveness of the HIV & TB response o Strengthen and improve access to institutions and services, especially primary institutions o Strengthen the use of quality epidemiological and program information to inform planning, policy and decision making o Improve planning and management of human resources to meet the changing needs of the epidemic o Improve health care and prevention financing

22. Governance & Management Structure High-level Steering Committee o Strategic direction o Governance Management-level Committee o Management o Coordination Key Elements o Joint oversight of PF and its implementation o Annual evaluation and review o Annual adjustments as needed

23. Where do we need to go? PFIP Development Treatment and Care to transition to the SAG Integrate with the NSP 2012 - 2016 Adopt and follow SAG priorities Integrate with the PHC and District Health System model Work with SAG to determine how NGOs can best contribute to this plan

24. Where are we going? PFIP Development Limit the amount of overlap to be efficient and effective Drive down the cost of service While strengthening the overall health system Prevention is the key to sustainability At all times ensure that care and treatment of patients is ensured

25. PFIP Development Bilateral PF Steering Committee includes Office of Deputy President, NDOH, DSD, DOE, DPSA and Treasury Align with the National Strategic Plan for HIV & Aids, STIs and TB (2012-2016) Work with provinces and districts Consultations

26. PFIP Development Provincial Consultations –Input on provincial and district needs early –Discussion of proposed PFIP –Discuss how NGOs can best contribute to this plan in provinces and districts PFIP will address national program with room for provincial and district “tailoring” of activities/effort

27. Transition, Technical Assistance, and Capacity Building Progressively transition delivery of services to SA DOH staff “Transfer” staff from PEPFAR NGOs to DOH Train new health care workers Train existing DOH staff to enhance skills Provide technical expertise for a period of time to transfer skills, build a system, etc.

28. Partnership Change is difficult Partnership and teamwork make things happen Together we have a chance to really make a difference

29. Thank You